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The researchers at OHSU analyzed 11 studies that evaluated the effectiveness of child abuse and neglect prevention programs or interventions that took place in clinics — such as meetings with a social worker, for example. They gave parents questionnaires that assessed such risk factors as substance abuse, depression, stress and attitudes toward physical punishment — as well as noting whether parents were concerned that their child may have been physically or sexually abused. Doctors discussed the risk factors with parents and referred them to social workers if needed. After three years, researchers found that parents who took part in risk assessments and received social work referrals, if necessary, had decreased incidences of abuse, fewer reports to Child Protective Services (CPS) and better adherence to immunization schedules.

But the studies’ results were not persuasive enough to warrant new recommendations for physicians, says Dr. Heidi Nelson, senior author of the study analysis published in Annals of Internal Medicine and a research professor in medical informatics, clinical epidemiology and medicine at OHSU. “This is not about identifying kids who are being abused,” says Nelson. “This is about determining if a family in front of me is at risk for abuse in the future.”

A major challenge with determining who is at risk for child abuse is how — and to whom — to pose questions. If the parents who bring a child to a check-up are mistreating that child, says Grossman, it’s not likely they will volunteer that information. “You are potentially asking the perpetrators if there is a problem,” he says.

While evidence underpinning the effectiveness of screening questions is scanty, home visits seem to have had more success. Last year, a study in the Journal of the American Medical Association (JAMA) found that home visits can cut child maltreatment cases by up to half. States determine eligibility for home visits in different ways, but poor moms, single moms, homeless moms, teen moms and those with a history of domestic violence typically top the list. Home visitors serve as a sounding board and support system, educating moms about normal infant behavior, cautioning them against shaking crying babies and offering suggestions for stress relief and interacting with their babies. Parenting can be overwhelming even for educated, well-to-do women, but those who are less fortunate stand to benefit even more from having someone help them navigate the challenges of child-rearing. In fact, when researchers evaluated the effect of home visitations, they found that those babies whose families were visited by nurses were less likely to die of all causes by age 9 than other children. Some studies showed that children who benefited from home visits had less contact with CPS and fewer trips to the hospital.

But other studies on home visits have shown mixed results, leading the task force to stop short of issuing a blanket recommendation for primary-care clinics across the U.S to adopt the program for families they perceive to be at risk. “It’s one thing to say that it’s a good idea, but it’s another to say that we have definite proof,” says Nelson.

The task force last took up this issue in 2004; it will take another look at any new studies that have emerged five years from now to see if things have changed. In the meantime, for the next 30 days the public is welcome to submit comments on the task force’s preliminary recommendations. “We are looking to see if we missed any key pieces of evidence,” says Grossman.

An Abington woman, accused with her ex-boyfriend in connection with the abuse and neglect suffered by an infant boy in their care, is behind bars for her “atrocious” conduct.
Colleen Melissa Miller, 32, of the 1000 block of Tyson Avenue, was sentenced in Montgomery County Court to 11 ½ to 23 months in the county jail after she pleaded guilty to misdemeanor charges of endangering the welfare of a child and recklessly endangering another person in connection with her contact with the 7-month-old child.
“Essentially, she is admitting that she left this child alone with a man that she knew to be very violent and dangerous … which exposed that child to the risk of serious bodily injury, and that child was seriously injured while in that man’s care,” said Assistant District Attorney Samantha Cauffman, who argued for significant jail time against Miller.
Judge Thomas C. Branca also ordered Miller to complete three years’ probation after she’s paroled from jail and to undergo intensive drug, alcohol and mental health treatment as conditions of the sentence. The judge said Miller is eligible for the jail’s work release program but is prohibited from having any contact with the child.With the charges, authorities alleged Miller left the child, for whom she was caring, alone with her former boyfriend, John Matthew O’Neill, even though she had a protection order against O’Neill, and then didn’t seek immediate medical care for the child when she returned home from a night of drinking and discovered the child suffered serious injuries to his anus, allegedly at the hands of O’Neill.

“What this woman did, by leaving this child to the whims of a very dangerous man, is atrocious, and she needed to pay for her actions, which were much more than just a series of bad decisions,” said Cauffman, who previously argued Miller “violated the most sacred duty” a person can have, which is to keep a child safe.

Defense lawyer Mark A. Hinrichs argued for leniency, in the form of probation, for Miller.

O’Neill, 33, of the 1400 block of Arnold Avenue, Abington, is still awaiting trial on charges of involuntary deviate sexual intercourse, sexual assault, aggravated indecent assault of a child, indecent assault of a child, reckless endangerment, child endangerment and simple and aggravated assault in connection with his alleged contact with the 7-month-old infant.

Cauffman said the child is “on the road to recovery” from his injuries.

O’Neill, who remains in the county jail, allegedly gave conflicting statements to detectives about the cause of the child’s anal injuries, including claiming a pet cat caused the injuries or that the child fell against a bathtub fixture during bathing, according to the arrest affidavit.“O’Neill admits being the sole caretaker of [the child] prior to and during the time where [the child] received his injuries,” Abington Detective Michael Begley alleged in the criminal complaint.

The investigation determined Miller, at about 10 p.m. Aug. 12, 2011, allowed O’Neill, her ex-boyfriend, to come to her home, even though she had a valid protection from abuse order that prohibited O’Neill from being at her residence, and asked him to stay with a child that was in her care while she went out with her new boyfriend, court papers indicate.

Miller allegedly returned home at 3 a.m. Aug. 13. After a brief discussion during which O’Neill allegedly stated the child was “fine,” Miller asked O’Neill to leave the residence. As O’Neill left he allegedly stated to Miller, “There’s blood in the trash can, it’s from me,” according to the arrest affidavit.

When Miller checked on the child she noticed blood on the bedding.

“She also found blood throughout other areas of the house. Miller found blood splatter, bloody diapers, towels, sheets and baby wipes,” Begley alleged, adding Miller noticed something unusual about the child’s anal area while removing the child’s diaper.

At about 4:40 a.m. Miller allegedly sent a text message to a relative stating, “You need to come, what I have to show you is not good,” according to the arrest affidavit. However, even after Miller couldn’t reach her relative, Miller did not call for medical assistance for the child, authorities alleged.

Miller’s relative, retrieving the message about six hours later, rushed to her home at 10:45 a.m. and found the child “unresponsive but breathing,” and noticed the child’s anal injuries and bruising to both sides of his head at his temples and under his jaw, according to the criminal complaint. Miller’s relative rushed the child to Abington Memorial Hospital.
The child underwent emergency surgery for what doctors described as “horrific injuries to the anus area,” which were life-threatening, according to court documents.

When authorities took O’Neill into custody, they discovered what appeared to be a blood “splatter mark” on the top of his right shoe, according to the arrest affidavit.
Due to the child’s critical condition, the little boy was transported to The Children’s Hospital of Philadelphia where doctors diagnosed the injuries to the child’s anus as “violent trauma,” including perforation of the intestines, according to the criminal complaint.

The child underwent emergency surgery for what doctors described as “horrific injuries to the anus area,” which were life-threatening, according to court documents.

When authorities took O’Neill into custody, they discovered what appeared to be a blood “splatter mark” on the top of his right shoe, according to the arrest affidavit.